Hypertension and burden of myocardial infarction in China: risk factors, gender differences and temporal trends from a National Chronic Disease Surveillance study (2021–2023)

<b>Background:</b> Myocardial infarction (MI) remains a leading global cause of morbidity and mortality, with rising prevalence in China. Hypertension persists as a predominant modifiable risk factor. This study investigates MI prevalence, trends and risk factors using data from China CDC's Chronic Disease Surveillance program. <b>Methods:</b> Data from 258,742 participants (2021-2023) were analysed. Demographic characteristics, risk factors and gender/urban-rural disparities in MI prevalence were assessed. Multivariate logistic regression identified significant risk factors. <b>Results:</b> Hypertension was the leading MI risk factor (64.3%), followed by dyslipidaemia (58.6%) and smoking (42.3%). Men had higher MI prevalence than women (58.2% <i>vs</i>. 41.8%), and urban residents surpassed rural residents (56.7% <i>vs.</i> 43.3%), with significant lifestyle disparities (e.g. physical inactivity and smoking). Multivariate analysis identified age ≥ 60 years (OR = 2.75, 95% CI: 2.46-3.08), hypertension, dyslipidaemia, smoking and obesity (BMI ≥ 25) as key risk factors. MI incidence increased by 3.14% nationally from 2021 to 2023. <b>Conclusions:</b> China's MI burden is escalating, with notable gender, age and residence disparities. Older adults and individuals with hypertension, dyslipidaemia, smoking or obesity face elevated risks. Hypertension contributes to nearly two-thirds of MI cases, emphasising the urgency for targeted prevention strategies, particularly in high-risk groups (hypertensive individuals, older adults and urban populations).